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Illiotibial band syndrome - itb syndrome

Illiotibial band syndrome - itb syndrome represents one of the most common injurie that affect the runners, and belongs to a group of diseases that we can call overuse syndrome.

Laura Kennelly was a runner for a few years before she experienced any pain. Two days after her first marathon she followed her runner's group for a light eight kilometer run. But after three kilometers she felt pain on the outer side of her leg. „My foot just collapsed. I stopped running and could barely walk, „ Laura reminisces, „I went home, dragging my leg.“ 

Laura Kenelly, writer from Berea in the state of Ohio, had iliotibial tendon syndrome – one of most common runner's injuries. Most noticeable symptoms include swelling and pain on the outer side of the knee, so many runners think it's an injury to the knee.  
But, that's not the case here. It is a band that connects the hip all the way to the thigh and shin. „When the tendon gets squashed near the knee, friction between the tendon and the bone occurs. This causes inflammation,“ says Freddie H. Fu , orthopedic surgeon from Pittsburgh, and chair of Pittsburgh Marathon Board.

ITB syndrome (iliotibial band syndrome) can be caused by any activity which will cause repeated twisting of the leg inwards. Other causes involve worn out shoes, running downhill or on the slopes in the same direction, or simply – too many kilometers. Unlike many other injuries specific for those who over train, this condition affects all types of runners.

"Forty percent of runners who suffer from ITB syndrome run for five or more years, " says John Pagliano, sports medicine physician and podiatrist from Long Beach, California – marathoner with 2:26 best time. „Around 50% of runners run 30 to 60 kilometers weekly. The syndrome affects women even more, „ says Pagliano. „Why? Probably because hips of some women are curved so as to cause twisting the knee inward.“

Some experts claim that ITB syndrome is more common nowadays, even though there are no clear reasons for this statement. „The reason might be that some runners went up on their mileage in a short time, and weren't quite ready for it, „ says Stephen Pribut, sports podiatrist from Washington.

Dr. Pagliano also adds: „We are also talking about runners who run a lot even after they feel the pain, because they believe it will cease by itself.“ How can you check if you have ITB? „It's best, “ says Fu, „to bend your knee at 45 degrees and you will feel pain on the outer side of the knee. Sometimes it can be diagnosed with nuclear magnetic resonance. X-rays usually gets no clear result, but nuclear magnetic resonance can show tendon thickening caused by inflammation.“

These are some suggestions that can help you prevent ITB:
  • First and foremost, if you feel the pain on the outer side of your knee, you must reduce the mileage or take a short break from running.
  • Walk for 400 to 800 meters before you start running.
  • Check if the soles of your shoes are worn out. If so, buy new shoes.
  • Run in the middle of the road, where it's straight. (In order to do that, find a road with no traffic and good visibility.)
  • Don't run on asphalt.
  • When running on the track, change direction of running frequently.
  • Visit a doctor for advice on any insoles for your shoes.
  • Avoid squats.

Once you experience ITB pain, the best way to get rid of it is rest. This means reducing the mileage or no running at all.

„With most runners – 85% - once they rest, the pain doesn't return, “ says Dr. Pagliano. „But this doesn't include those who – finally – decided to rest after running 150km weekly for six months. Rest should follow immediately after the injury is diagnosed.“

When you reduced the mileage, you can replace it with some other activity. Swimming, running in the pool, cycling, and rowing, are good alternatives. Going up the stairs is not a good replacement because it is too similar to running.

Lateral stretches can also help, and ice as well, along with hot compresses, ultrasound, or electro stimulation with local cortisol application. This last method is useful especially „in the acute phase, “ says Dr. Fu.

If you don't stop with your runs, ITB syndrome can become chronic. „Then you'll have to run shorter races and give up on marathons, “ continues Fu.

If after few weeks of rest problem persists, seek professional help in area of sports medicine. Maybe you will need cortisone injection into damaged connective tissue to speed up the recovery. But, cortisone has a dark side – it can weaken ligaments and tendons. Consider cortisone injections „next to last solution, “ says Dr. Pagliano.

Last solution is surgery. „Once when you tried everything without success, surgery can relax your iliotibial tendon, “ says Fu comfortingly. But Pagliano warns: „Surgery is never the best solution, because it leaves the knee unstable – and patients never like it.“
And Laura Kenelly reports: „I've had many injuries – even a broken bone in the foot – but none took this long to heal or came back so many times as ITB syndrome. Now I know I must be aware of this weakness and stop running when it presents itself.“


In order to run pain free, you must keep your IT tendon flexible. These two stretching exercises can help:

  • Place your right hip near the wall, and cross your left leg behind the right one. Lift both arms overhead and put your palms together. Bend the upper part of your torso to the left. You should feel stretching along the left side, from the knee, through the thigh, to the hip. Hold for 15 to 30 seconds. Switch sides and repeat. Do these two or three times per day.
  • Sit on the floor and bend left leg to 90 degrees, keeping your left foot on the ground. Bend your right leg and cross it over the left knee. Use the weight of your right leg to pull left knee to the right, checking if the left foot remained on the ground. You should feel stretching on the outer part of your left hip and thigh. Hold for 15 to 30 seconds. Switch sides and repeat. Do these two or three times per day.
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